[Weaning of immunosuppression in living-related liver transplantation]

In our experience of living donor liver transplantation (LDLT), some recipients could be successfully weaned from any immunosuppressant in case of various situations like severe infectious complications, posttransplant lymphoproliferative disorder, and noncompliance. Based on such unexpected experiences, we started the intentional weaning of immunosupressants after LDLT. The patients were selected among the recipients who had been followed up longer than two years with stable normal graft function, and without any rejection episodes in the latest one year. So far, 26 cases were enrolled into this program, and 6 cases could be intentionally weaned from any immunosuppressants. Four recipients unfortunately had a rejection episode during the weaning. Immunosuppressants were again returned to the pre-weaning level in these recipients, and the rejection could be treated without any persistent dysfunction of the graft. Clear discrimination of the recipients who will be or will not be able to be weaned from immunosuppression is still impossible. Mixed lymphocyte reaction showed tendency of low response to the donor, but the result is not stationary in all recipients. Identification of suitable parameters to promise the possibility of weaning is a big problem to be solved in the future.